RUPTURE OF THE SPLENIC ARTERY IN PAN CREATIC PSEUDOCYST

Abstract

Hemorrhage is one of the most threatening complication of pancreatic pseudocyst. It results from erosion of adjacent vessels. Splenic, gastroduodenal, pancreaticoduodenal and middle colic vessels are predominantly involved. Hemorrhage may present different feature: intra and/or extraperitoneal collection, gastrointestinal bleeding.

The authors report the rupture of splenic artery into pseudocyst, with the formation of pulsating pseudoaneurysm, increasing progressively until the final rupture.

For the diagnosis the authors utilized: ultrasounds (US) which showed the cyst but not its nature and content; the CT scan which disclosed haematic contents; finally the US Color Doppler which proved the dynamic feature of hemorrhage. This technique allows to identify the arterious or venous source of bleeding and the possible presence of arteriovenous fistula.

Arteriography was not performed due to circumstances, although it would permit bleeding vessel embolization and the control of hemorrhage. This procedure is not ever achievable, and doesn’t exclude the possibility of rebleeding.

On surgery, since the intraoperative rupture of the pseudoaneurysm occurred with severe hypovolemic shock, only a timely posterior mesogastric mobilization and the medially displacement of spleen-body-tail pancreatic complex, allowed to clamp the mass and the hemostasis.

When such lesion are approached, it is mandatory to be prepared to carry on this maneuver: the severity of bleeding cannot allow intracystic ligature of bleeding vessel.